First Aid USMLE Step 2 CS: Challenging Questions And
Answers 2022
A patient who needs emergent surgery says, "I can't afford the cost of staying in the hospital. I have no
insurance. Just give me something to relieve the pain, and I will leave." Correct Answer: "I know that
you are concerned about medical costs, but your life will be in danger if you don't have surgery. Let our
social workers help you with the cost issues."
"Should I tell my sexual partner about my venereal disease?" Correct Answer: "Yes. There is a chance
that you have already transmitted the disease to your partner, or he/she may be the source of your
infection. The important step is to have you both evaluated and appropriately treated."
An anxious patient who you suspect has been abused asks, "Why are you asking me these questions?"
Correct Answer: "I am concerned that domestic abuse may be involved. My goal is to make sure that
you are in a safe environment and that you are not a victim of abuse."
A patient recently diagnosed with HIV asks, "Do I have to tell my wife?" Correct Answer: "I know that
it's difficult, but doing so will allow you and your wife to take the appropriate precautions to treat and
prevent the transmission of the disease."
An elderly patient says, "I think that it is normal at my age to have this problem" (impotence), or "I am
just getting old." Correct Answer: "Not necessarily. Age may play a role in the change you are
experiencing in your sexual function, but your problem may have other causes that we should rule out,
such as certain diseases, such as hypertension and diabetes, or certain medications. We also have
medications that may improve your sexual function."
"I read in a journal that the treatment of this disease is herbal compounds." Correct Answer: "Herbal
medicines have been suggested for many diseases. However, their safety and efficacy may not always be
clear-cut. Let me know the name of the herbal medicine and I will check into its potential treatment role
for this disease."
"I am afraid of surgery." Correct Answer: "I understand your feelings. It is normal and very common to
have these feelings before surgery. Is there anything specific that you are concerned about?"
A patient who has a serious problem (unstable angina, colon cancer) asks, "I want to go on a trip with
my wife. Can we do the tests after I come back?" Correct Answer: "I know that you don't want to put off
your trip, but you may have a serious problem that may benefit from early diagnosis and management.
Also, it is possible you could suffer complications from the problem while you are on vacation if we do
not effectively deal with it before you leave."
"I did not understand your question, doctor. Could you repeat it, please?" Correct Answer: Repeat the
question again slowly. If the patient still doesn't comprehend the question, ask if there is any specific
word he didn't understand and try to explain it or use a simpler one.
"What is a bronchoscopy?" (MRI, CT, x-ray, colonoscopy) Correct Answer: Explain the meaning using
simple words. For example, "Bronchoscopy is using a thin tube connected to a camera to look into your
, respiratory airways and parts of your lungs," or "An MRI is a machine that uses a big magnet to obtain
detailed pictures of your brain or body."
"What do you mean by 'workup'?" Correct Answer: "It means all the tests that we are going to do to
help us make the final diagnosis."
A patient who is late in seeking medical advice asks, "Do you think it is too late for recovery?" Correct
Answer: "It is never too late to seek help, and I am glad you made the decision to pursue treatment
options with me. We will do our best to help you, but next time I want you to feel comfortable coming
to me as soon as you feel you might have a problem."
A patient with pleuritic chest pain asks, "Is this a heart attack? Am I going to die?" Correct Answer: "On
the basis of your history and my clinical exam findings, my suspicion for a heart attack is low. It is more
likely that inflammation of your lungs is causing your pain, and this is usually not a life threatening
condition. However, we still need to do some tests to confirm the diagnosis and rule out heart
problems."
A patient with chest pain concerning for a MI asks, "Is this a heart attack? Am I going to die?" Correct
Answer: Your symptoms are concerning. We need to more about what is going on to determine if this is
life threatening.
"Do you think I have colon cancer?" "Do you think I have a brain tumor?" "Do I have endometrial
cancer?" Correct Answer: If the patient's chief complaint is consistent with his question, tell them, "That
is one of the possibilities, but there are other explanations for your symptoms that we should rule out
before making a diagnosis." However, if the chief complaint is inconsistent with their concern, say, "It is
unlikely for a patient with you complaint to have that type of cancer, but if you are really worried about
it, I will try to rule it out by conducting some tests."
"My friend told me that you are a very fine doctor. That's why I came to you to refill my prescription."
Correct Answer: "I am happy you came to see me, but since this is your first visit, I can't give you a refill
without reviewing your history to better understand your need for this medication. I will also need to do
a physical exam and perhaps order some tests."
"Will my insurance cover the expenses of this test?" Correct Answer: "I'm not sure, but I can refer you
to a social worker who does have that information. If necessary, I can write a note to your insurance
company indicating the importance of this test."
A person who wants to return to work at a job that can negatively affect his health asks, "Can I go back
to work?" Correct Answer: "Unfortunately, work may actually worsen your condition. Therefore, I
would prefer that you stay at home for now. I can write a letter to your employer explaining your
situation."
"Do you think that this tumor I have could become malignant?" Correct Answer: "We really won't know
until we remove the mass and get a pathology report on it. We will keep you informed as soon as we get
any information."
Answers 2022
A patient who needs emergent surgery says, "I can't afford the cost of staying in the hospital. I have no
insurance. Just give me something to relieve the pain, and I will leave." Correct Answer: "I know that
you are concerned about medical costs, but your life will be in danger if you don't have surgery. Let our
social workers help you with the cost issues."
"Should I tell my sexual partner about my venereal disease?" Correct Answer: "Yes. There is a chance
that you have already transmitted the disease to your partner, or he/she may be the source of your
infection. The important step is to have you both evaluated and appropriately treated."
An anxious patient who you suspect has been abused asks, "Why are you asking me these questions?"
Correct Answer: "I am concerned that domestic abuse may be involved. My goal is to make sure that
you are in a safe environment and that you are not a victim of abuse."
A patient recently diagnosed with HIV asks, "Do I have to tell my wife?" Correct Answer: "I know that
it's difficult, but doing so will allow you and your wife to take the appropriate precautions to treat and
prevent the transmission of the disease."
An elderly patient says, "I think that it is normal at my age to have this problem" (impotence), or "I am
just getting old." Correct Answer: "Not necessarily. Age may play a role in the change you are
experiencing in your sexual function, but your problem may have other causes that we should rule out,
such as certain diseases, such as hypertension and diabetes, or certain medications. We also have
medications that may improve your sexual function."
"I read in a journal that the treatment of this disease is herbal compounds." Correct Answer: "Herbal
medicines have been suggested for many diseases. However, their safety and efficacy may not always be
clear-cut. Let me know the name of the herbal medicine and I will check into its potential treatment role
for this disease."
"I am afraid of surgery." Correct Answer: "I understand your feelings. It is normal and very common to
have these feelings before surgery. Is there anything specific that you are concerned about?"
A patient who has a serious problem (unstable angina, colon cancer) asks, "I want to go on a trip with
my wife. Can we do the tests after I come back?" Correct Answer: "I know that you don't want to put off
your trip, but you may have a serious problem that may benefit from early diagnosis and management.
Also, it is possible you could suffer complications from the problem while you are on vacation if we do
not effectively deal with it before you leave."
"I did not understand your question, doctor. Could you repeat it, please?" Correct Answer: Repeat the
question again slowly. If the patient still doesn't comprehend the question, ask if there is any specific
word he didn't understand and try to explain it or use a simpler one.
"What is a bronchoscopy?" (MRI, CT, x-ray, colonoscopy) Correct Answer: Explain the meaning using
simple words. For example, "Bronchoscopy is using a thin tube connected to a camera to look into your
, respiratory airways and parts of your lungs," or "An MRI is a machine that uses a big magnet to obtain
detailed pictures of your brain or body."
"What do you mean by 'workup'?" Correct Answer: "It means all the tests that we are going to do to
help us make the final diagnosis."
A patient who is late in seeking medical advice asks, "Do you think it is too late for recovery?" Correct
Answer: "It is never too late to seek help, and I am glad you made the decision to pursue treatment
options with me. We will do our best to help you, but next time I want you to feel comfortable coming
to me as soon as you feel you might have a problem."
A patient with pleuritic chest pain asks, "Is this a heart attack? Am I going to die?" Correct Answer: "On
the basis of your history and my clinical exam findings, my suspicion for a heart attack is low. It is more
likely that inflammation of your lungs is causing your pain, and this is usually not a life threatening
condition. However, we still need to do some tests to confirm the diagnosis and rule out heart
problems."
A patient with chest pain concerning for a MI asks, "Is this a heart attack? Am I going to die?" Correct
Answer: Your symptoms are concerning. We need to more about what is going on to determine if this is
life threatening.
"Do you think I have colon cancer?" "Do you think I have a brain tumor?" "Do I have endometrial
cancer?" Correct Answer: If the patient's chief complaint is consistent with his question, tell them, "That
is one of the possibilities, but there are other explanations for your symptoms that we should rule out
before making a diagnosis." However, if the chief complaint is inconsistent with their concern, say, "It is
unlikely for a patient with you complaint to have that type of cancer, but if you are really worried about
it, I will try to rule it out by conducting some tests."
"My friend told me that you are a very fine doctor. That's why I came to you to refill my prescription."
Correct Answer: "I am happy you came to see me, but since this is your first visit, I can't give you a refill
without reviewing your history to better understand your need for this medication. I will also need to do
a physical exam and perhaps order some tests."
"Will my insurance cover the expenses of this test?" Correct Answer: "I'm not sure, but I can refer you
to a social worker who does have that information. If necessary, I can write a note to your insurance
company indicating the importance of this test."
A person who wants to return to work at a job that can negatively affect his health asks, "Can I go back
to work?" Correct Answer: "Unfortunately, work may actually worsen your condition. Therefore, I
would prefer that you stay at home for now. I can write a letter to your employer explaining your
situation."
"Do you think that this tumor I have could become malignant?" Correct Answer: "We really won't know
until we remove the mass and get a pathology report on it. We will keep you informed as soon as we get
any information."
